Tobacco Control: A Winnable Battle

1. Tobacco Control:A Winnable Battle U.S. Department of Health and Human Services Centers for Disease Control and Prevention

2. Tobacco use damages virtually every part of the body Smoking Secondhand Smoke

3. Tobacco use is still the leading preventable cause of death in the U.S. • 46.6 million U.S. adults smoke • Tobacco causes nearly 1 in 5 deaths in U.S. • >440,000 deaths/year, >1,200/day • For each death, it is estimated that 20 more suffer tobacco-related illnesses • Annual costs: $96 billion in medical expenses plus $97 billion in lost productivity • Many Americans left unprotected, especially service industry workers • 26 states still lack comprehensive smoke-free laws

4. Tobacco kills about 443,000 in the U.S. every year Average annual number of deaths, 2000-2004. Source:Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses – United States, 2000-2004. MMWR 2008;57(45):1226-1228.

5. The decline in adult cigarette smokinghas stalled Civilian, non-institutionalized adults, aged 18 years of age and over, who currently smoked cigarettes. Source: National Health Interview Surveys, 1965-2009.

6. Smoking rates vary widely by race/ethnicity Note: Question wording changed in 1992 in order to identify smokers who smoked less than daily. This graph includes all smokers, regardless of frequency. Source: National Health Interview Survey, 1978-2009; data aggregated for selected years.

7. Smoking rates vary widely by state/region Note: Persons who have smoked at least 100 cigarettes in lifetime and currently smoke everyday or some days. Source: Behavioral Risk Factor Surveillance Survey, NCCDPHP, CDC, 2009.

8. Heart disease deaths are closely aligned with smoking Heart Disease Death Rates, 2000-2004Adults ages 35 Years and Older by County Source: Vital Records; National Center for Health Statistics, CDC, 2000-2004. Division for Heart Disease and Stroke Prevention: Data Trends & Maps Web site. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, 2010. Available at http://www.cdc.gov/dhdsp/.

9. Short-term impact of a comprehensive approach:Youth and adult smoking rates in NYC Source: BRFSS 1993-2001; NYC Community Health Survey 2002-2009; NYC YRBS 2001-2009.

10. Long-term impact of a comprehensive approach:Lung and bronchus cancer incidence rates in CA California: A 15 year investment of $1.8 billion in tobacco control reduced health care costs by $86 billion Rates are per 100,000 and age-adjusted to the 2000 U.S. standard (19 age groups). * The annual percent change is significantly different from zero (p<0.05). Source: Cancer Surveillance Section. Prepared by: California Department of Public Health, California Tobacco Control Program, 1988-2005. 2010.

12. We know what works • Sustained funding of comprehensive programs • Excise tax increases • 100% smoke-free policies • Aggressive media campaigns • Cessation access • Comprehensive advertising restrictions

13. The tobacco industry is outspending tobacco prevention efforts 20:1 Sources: Campaign for Tobacco Free Kids; Federal Trade Commission; CDC Office on Smoking and Health.

14. When tobacco control funding increases, high school smoking decreases Source: Project ImpacTEEN; University of Illinois at Chicago; State University of New York at Buffalo; Youth Risk Behavior Survey, 1993-2009. * Adjusted to 2009 CPI. † High school students (grades 9-12) who smoked on 1 or more of the 30 days preceding the survey.

15. When cigarette prices increase, cigarette sales decrease Source: ImpacTeenChartbook: Cigarette Smoking Prevalence and Policies in the 50 States.

16. Increased tobacco excise taxesincrease price • 10% increase in cigarette prices  4% drop in adult cigarette consumption • Youth much less likely to start smoking when prices are high • Adjust taxes to offset inflation and tobacco industry attempts to control retail prices • E.g., promotional discounts for retailers who reduce cigarette prices • Tobacco taxes are the single most effective component of a comprehensive tobacco control program

17. Smoke-free policies save lives • Prevent heart attacks • Up to 17% average reduction in heart attack hospitalizations in places that enact smoke-free laws • Help motivate smokers to quit • Worker safety issue – not “personal nuisance” • All workers deserve equal protection • Only way to protect non-smokers from secondhand smoke • Smoke-free workplace laws don’t hurt business • No trade-off between health and economics

18. 25 states and D.C. have comprehensive smoke-free indoor air laws Laws in effect as of November 10, 2010 Source: CDC, Office on Smoking and Health. State Tobacco Activities Tracking and Evaluation (STATE) System.

19. Almost 50% of U.S. population is covered by comprehensive state or local smoke-free laws Population figures are as of December 31 of each given year; July for 2010. All population figures are from the United States Census. Source: American Nonsmokers’ Rights Foundation, 2000-2010.

20. Aggressive media campaigns work Media campaigns work to: • Reduce youth initiation • Encourage cessation • Increase negative attitudes toward tobacco use • Increase support for policy change

21. The impact of cessation services • Currently: 46.6 million U.S. smokers • 70% of smokers want to quit • 40% try to quit each year • Only 2% call state or national quitlines • Medicaid coverage for cessation varies widely among states • Tobacco cessation can be achieved through: • Significant tax and price increases • Comprehensive smoke-free policies • Aggressive counter-advertising

22. State and federal policy activities (2009-2010) • Excise Tax Increases • 21 state increased cigarette taxes • Smoke-Free Policies • 10 additional states achieved comprehensive status • Federal Legislation • Federal excise tax increase • Family Smoking Prevention and Tobacco Control Act • Prevent All Cigarette Trafficking (PACT) Act • Affordable Care Act

23. Closing Statement U.S. Department of Health and Human Services Centers for Disease Control and Prevention